Healthcare Provider Details

I. General information

NPI: 1588023873
Provider Name (Legal Business Name): RANDALL HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 N LINCOLN AVE SUITE 2
LOVELAND CO
80537-4877
US

IV. Provider business mailing address

1135 N LINCOLN AVE SUITE 2
LOVELAND CO
80537-4877
US

V. Phone/Fax

Practice location:
  • Phone: 970-292-8023
  • Fax: 970-292-8459
Mailing address:
  • Phone: 970-292-8023
  • Fax: 970-292-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA7090
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA223
License Number StateCO

VIII. Authorized Official

Name: MR. RANDALL L HOLYFIELD SR.
Title or Position: OWNER
Credential: BC-HIS ACA
Phone: 970-292-8023